communication needs at user and provider levels, and vaccine use including supply issues.

The health infrastructures in many low- and middle-income countries do not adequately support use of needed vaccines. Causes include inability to pay for vaccines, inadequate infrastructure (ranging from public health laboratories to refrigerators), lack of providers or paraprofessionals to administer vaccines safely, and lack of systems to monitor vaccine use and potential adverse events. Without adequate infrastructure, funding for vaccines alone will not get vaccines to those who need them most.

Recommendation 5-1: The National Vaccine Plan should call forthe engagement of U.S. federal agencies and partners to supportimmunization capacity-building to implement new vaccines inlow- and middle-income countries through the provision of expertise and financial resources necessary to incorporate new vaccines,strengthen immunization infrastructure, and achieve higher levelsof vaccination. One infrastructure component requiring specificattention is the development and implementation of surveillancesystems for vaccination, disease burden, and vaccine safety that areinnovative and appropriate for developing countries.

Recommendation 5-2: The National Vaccine Plan should endorseactive U.S. engagement in the development of global policy frameworks to further global adherence to differential pricing in orderto ensure access to needed vaccines in all countries.

REFERENCES

Goldberg, R., and P. Pitts. 2006. Prescription for progress: The critical path to drug development; a working paper of the 21st century FDA Task Force. New York: Center for Medical Progress, Manhattan Institute for Policy Research.

Gross, C.P., G.F. Anderson, and N.R. Powe. 1999. The relation between funding by the National Institutes of Health and the burden of disease. NEJM 340(24):1881-1887.